Healthcare Provider Details

I. General information

NPI: 1194689588
Provider Name (Legal Business Name): DAMO VITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W PARK AVE STE 312C
LONG BEACH NY
11561-3344
US

IV. Provider business mailing address

120 W PARK AVE STE 312C
LONG BEACH NY
11561-3344
US

V. Phone/Fax

Practice location:
  • Phone: 516-724-8013
  • Fax: 516-724-8014
Mailing address:
  • Phone: 516-724-8013
  • Fax: 516-724-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DAMOLIE KEMONE WILLIAMS
Title or Position: CEO
Credential:
Phone: 347-929-3239